| NPI | 1699144170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 3577) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA057825) |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2020-12-16 |